Copy and paste the following statements and put an x on the ones that apply to you. Send it to Dr. Kwik.

Living alone or having difficulty getting around and being mobile

  • Poor immune health

  • Health problems that make it harder for you to cook or feed yourself

  • Problems chewing or swallowing food

  • Loss of appetite

  • Oral health (teeth sensitivities, dentures, etc.)

  • Medications that interfere with appetite or cause nausea

  • Limited budget for food expenses

  • Sense of smell and taste

  • Low energy and motivation

  • Depression